At the present time the cesarean section, commonly called "c/section", is one of the most widely used surgical procedures. According to the American College of Obstetrics and Gynecology, there were 799,033 cesarean sections performed in the United States in 1997. This represents approximately 25% of all deliveries; however, the specific rate of cesarean sections varies among hospitals and individual doctors.
A cesarean section is a major surgical procedure in which a baby is removed from the uterus by making a cut into the abdomen and then into the uterus. In many cases a cesarean section is necessary to save the life of the baby or the mother. In other cases a cesarean section is performed when a vaginal birth is not possible, e.g., failure of normal progression of labor. In some other cases a cesarean section may be scheduled due to a patient's request, or recommended by another doctor.
There are a number of potential complications that may occur as a result of a cesarean section. The complications include, but are not limited to, infection, bleeding, traumatic injury and death. It is estimated that the chance of dying from a cesarean section, which is a major abdominal surgery, is about 0.02% (20 out of 100,000), which is higher than the chance of dying from vaginal delivery. The reason cesarean sections may involve so many complications is because they involve opening up the abdomen and making an incision into the uterus. When doing a cesarean section an obstetrician/gynecologist (ob/gyn) doctor first makes sure that the patient has adequate anesthesia. They commonly use epidural or spinal anesthesia. On unusual occasions the patient may need to have general anesthesia, which involves putting the patient completely to sleep with a tube in the throat and the use of a ventilator device. Once the patient is anesthetized, a transverse incision about the size of the distance from the wrist to the tip of the ring finger is made into the skin, using a sharp scalpel. In most cases this incision is made from side-to-side, just above the pubic hair line (sometimes called a "bikini cut"). In other countries, and in some emergency situations, an up-and-down cut is made below the belly button to the top of the bikini line. Most doctors prefer bikini cuts because they heal and look better, and cause less pain after leaving the hospital. After cutting through the skin and underlying fat cells, the doctor will make a transverse incision, using a sharp scalpel, through the remaining tissue and then will enter the abdominal cavity. The bladder, uterus, ovaries, tubes and intestines are all visible. The vesicouterine fold is opened and the bladder is retracted. The uterus is then cut. When the uterus is cut the amniotic fluid will flow out, although in some cases there is only a small amount. Some doctors will then enlarge the cut in the uterus using their fingers. An alternative for lengthening the incision is to use a special scissor. After entering the uterus through the cut, the baby is carefully grasped, and the surgical assistant pushes on the top of the uterus to deliver the baby through the hole in the uterus.
Cesarean sections are a major surgery and can have many complications. Some complications that can occur, during or after a cesarean section, include heavy bleeding which may require blood transfusions, damage to the bladder or intestines, damage to blood vessels, infections of the uterus, kidneys, lungs or other areas, opening up of the skin incision, blood clots around the uterus or in the leg veins or lungs, and an inability of the blood to clot. On rare occasions, a hysterectomy may be performed to save the mother's life.
One of the most troubling adverse risks of cesarean sections is the possibility of cutting or nicking the baby while it is in the uterus, causing it to bleed. In some cesarean sections, and at some times, there is very little amniotic fluid to protect the baby. The baby, due to its position, may have a part of its body directly in contact with the inner wall of the uterus at the position where the doctor makes the incision through the uterus. The sharp scalpel may cut or nick the baby, causing an accidental laceration (cut). The baby's laceration, which is unexpected, may lead to extensive scarring and disfigurement. Such scarring and disfigurement may cause permanent or long-term damage, for example, amputation of a finger. Laceration of the nose, eyes, mouth or internal organs may be difficult or impossible to repair.
The cesarean section begins with an incision or cut on the skin. This cut is carried deeper until the abdomen is completely open (into the peritoneal cavity). The bladder, which is normally attached to the front of the uterus, is released. This is done by cutting the attachments of the bladder to the uterus and pushing it away. A cut is then made in the uterus. This cut is then carried deeper until the uterine wall is completely divided. The uterine incision is then extended by tearing the tissue or cutting it with a sharp scissor. The amniotic cavity, a baby sac with its surrounding fluid ("waters") is opened. The baby is then delivered and handed to the pediatric or baby care team. The after-birth, or placenta, is removed. The incision is closed and the abdominal wall is reapproximated.
Several points should be emphasized. The uterine wall can vary greatly in thickness, due to individual variation, prior surgery, the result of labor, and other factors. The amount of amniotic fluid present, that normally cushions the baby, can also vary markedly (even be depleted), especially following rupture of the membrane. These factors underscore the difficulty in creating the incision and may predispose a cesarean section to complications, involving both the mother and the baby.